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Study: Fewer Injured Workers Prescribed Opioids After Kentucky Reforms

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Workers injured on the job received fewer prescription opioids after landmark legislation passed in Kentucky that set up a drug monitoring database, according to a new study out Tuesday.

The independent Workers Compensation Research Institute reviewed new workers' comp claims filed in Kentucky between 2011 and 2014.

Prior to the 2011 law (HB 1) that created the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system, 54 percent of Kentucky workers with workers' comp claims were given a prescription for opioids. After the law took effect in 2012, that number decreased to 44 percent.

KASPER was created to monitor how often opioids were being prescribed and used. Kentucky was the first state to create this kind of law, and as of December 2016, 20 states had passed similar laws.

Vennela Thumula conducted research on the workers' comp study. Thumula said the group that experienced a decrease in opioid prescriptions was a very specific group of people. People ages 25-29 with back sprains and strains, but who had no surgery due to injury, saw a decline in the number of opioid prescriptions.

Thumula said there were no changes in the number of prescriptions written for people who had a major surgery because of an injury. People who had a fracture also didn’t see a big decrease in prescriptions. For both of these groups, there’s consensus among experts that opioid use is appropriate.

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Prior to the implementation of HB 1, 73 percent of injured workers living in Eastern Kentucky had an opioid prescription. That decreased to 63 percent after the law was passed. But in the rest of the state, the decrease went from 53 percent getting a prescription to 43 percent.

At the time the law passed, there was also speculation that alternative pain management methods like physical therapy might be used more. That did not happen.

“We didn’t see evidence of that, so that raises questions about whether utilization of opioids was necessary for the management of pain in the groups where we saw a reduction,” said Thumula said.

Thumula said further research is needed on the injured workers who had been prescribed opioids and were injured well before the law passed.

“If some of these injured workers stop receiving opioids completely after HB 1 instead of having a tapered reduction over time, it may indicate potential access problems,” Thumula wrote.

And indeed, there were big increases in heroin use and overdose rates after HB 1 was passed mandating doctors use KASPER. Though the drug overdose death rate dipped immediately after the law went into effect in 2012, drug overdoses were on the climb by 2015.

Fentanyl, a prescription painkiller that's often obtained illegally, is the main driver of that increase in deaths.

Lisa Gillespie is WFPL's Health and Innovation Reporter.

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